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Patient Blood Management (PBM) programs have become best practice across many hospitals and health systems over the last 30 years. Those who have empowered an identified clinical champion and built an infrastructure for change management are best prepared for disruptions in the supply chain, including blood and blood components and medications to treat anemia and limit bleeding that may occur. In the case of the COVID-19 crisis today, all these disruptions are potentially occurring at the same time.
The conditions and strategies that defined success for established PBM programs before the crisis, can now help inform new or developing programs on the most effective strategies to preserve and protect the blood supply and advance patient care during the challenge of the current pandemic.
Blood Transfusion become a critical factor in treating soldiers in WWII
In response to widespread transmission of disease, especially hepatitis, from donated blood, a move toward an all-volunteer, rather than paid blood donor system was made.
After increased research and clinical data, patient blood management programs, first called blood conservation programs or bloodless medicine and surgery programs are established to minimize transfusions and improve patient outcomes.
In 2005, Dr. Irwin Gross, a nationally recognized expert and published author in patient blood management and transfusion safety, established the PBM program at Eastern Maine Medical Center, where he was formerly Director of Laboratories and Chief of Pathology. He emphasizes two critical factors in establishing an effective patient-centered PBM program, improving patient outcomes, while minimizing dependence on donated blood.
“Change only happens within hospital systems when you have executive and clinical leadership committed to fostering a culture of adaptive change, and clinical champions committed to excellence in patient care.” This combination consistently generates the interest and momentum needed to establish an effective Patient Blood Management Program.
Changing clinical protocols and physician practices is challenging. Adoption of best practices at the bedside can take many years. The primary drivers for change in physician practices seen in PBM programs today are three-fold:
Over the last 10 to 15 years, the volume and depth of scientific information available regarding the risks and benefits of transfusion, and the superior clinical outcomes that are achieved by implementing the clinical practice of patient blood management, has increased at a rapid pace. This research has established PBM as the new standard of care, demonstrating the clinical and economic benefits of a robust and comprehensive PBM program.
Accurate physician-specific transfusion data demonstrates to practicing physicians the variation of practice between physicians caring for the same patient population. Combined with research data showing best practice, the ability to compare one’s transfusion practice with one’s peers is a powerful driver for change. Some would argue it is THE driver for change.
Busy hospitals and physicians with limited resources and competing priorities, can be slow to change even when there is a recognized need. Providing proven protocols and education to bridge the practice gap can markedly accelerate the transition to best practice. Resources from industry leaders supporting and driving innovation in blood management are critical to program strength, such as SABM.org and IFPBM.org.
As Patient Blood Management programs optimize patient outcomes, the importance of focusing on the data and evolving best practices is critical. A return to past practices is a common occurrence after initial implementation is complete, particularly with a large medical staff as new physicians and nurses replace staff that have left. Keeping the core Patient Blood Management benchmark numbers visible, processes accessible and education on-going, is essential for long-term success.
With a comprehensive PBM program, hospitals can minimize disruption in core services such as routine and even elective surgery that might arise because of disruption or shortages in the blood supply that may occur during a pandemic. PBM solutions will help facilitate the ability of healthcare systems to maintain or resume full care of our patient population.
– DR. IRWIN GROSS